tbuckley/cabot-search huggingface dataset:
Abstract 11532: Cardiac Complications in Polyarteritis Nodosa: A Case of Multi-Vessel Coronary Occlusion Treated With 4-Vessel Coronary Artery Bypass Grafting
Authors: Dylan J Walter, Grace E Bigham, Steven J Lahti, Jeffrey E Cohen, Syed W Haider
Journal: Circulation (2022)

Polyarteritis nodosa (PAN) is a necrotizing vasculitis causing intimal proliferation, luminal narrowing, thrombosis, ischemia, and even infarction. Coronary manifestations are rare, though recent evidence suggests coronary disease may progress rapidly causing significant morbidity and mortality. We report a case of multi-vessel occlusive coronary artery disease (CAD) in a patient with systemic PAN, successfully managed with 4-vessel coronary artery bypass grafting (CABG). An obese 53-year-old male with hypertension, hyperlipidemia, and tobacco use presented with episodic epigastric pain. Serial troponins and EKGs did not suggest cardiac ischemia. Cardiac MRI showed concentric LV hypertrophy with preserved systolic function without signs of infiltrative disease or fibrosis. Abdominal CT demonstrated splenic infarction, luminal narrowing of the celiac axis, and abdominal aortic and bilateral iliac artery aneurysms. MRA revealed inflammation of the celiac, splenic, and common hepatic arteries. CT angiography revealed beading of the superior mesenteric artery and celiac trunk, indicative of vasculitis. C3 and C4 levels were elevated. Polyarteritis nodosa was felt to be his unifying diagnosis. Prior to initiating cyclophosphamide, he returned with severe epigastric pain prompting admission. Endoscopy was negative. Coronary CT showed extensive calcification. Angiography revealed multi-vessel occlusive disease patterned with ectasia. He underwent 4-vessel CABG revascularization with LIMA-LAD and SVG-OM-LPDA-RPDA. After surgery, he began prednisone, dual anti-platelet, statin, beta-blocker, and angiotensin receptor blockade with rheumatology follow-up for optimal timing of cyclophosphamide initiation. For patients with systemic inflammatory conditions, recognition of atypical anginal events is crucial as typical identifiers of atherosclerosis may not be obvious. Bypass is definitive therapy, as stenting arteritic vessels may result in neo-endothelization. Clinicians must recognize increased risk of CAD while offering appropriate primary and secondary interventions such as screening imaging and knowledge of disease distribution for appropriate graft choice.
Abstract 12310: Comparison of Coronary Artery Calcium Quantification Methods in Statin Users and Non-Users
Authors: Woon Wei Ho, Alvin Chun Sheng Tan, Yilin Jiang, Felix Keng, Swee Yaw Tan, Lohendran Baskaran
Journal: Circulation (2022)

Background: Coronary artery calcium (CAC) can be quantified using various methods. The Agatston score (AS) computes the weighted sum of lesions with the maximum plaque attenuation factor. Calcium Volume measures the total volume of CAC, whereas Calcium Density has been shown to provide superior prognostication compared to the AS. Since statin use is associated with change in coronary plaque composition and thus CAC, we evaluated the difference CAC quantification methods among patients with suspected CAD receiving and not receiving statin therapy. Methods: Patients with suspected CAD and underwent cardiac computed tomography were recruited from a tertiary hospital in Singapore. Patient demographics and risk factors were obtained from electronic medical records. AS, Calcium Volume, Number of Lesions and Calcium Density were individually analysed with patient demographics and risk factors using multivariate models. Results were compared between patients on statins and not on statins to assess differences in CAC quantification methods. Results: Of the 528 patients, 43.0% were female, 40.9% had hypertension, 14.8% had diabetes, 44.3% had family history of CAD and 23.5% were smokers. While 58.5% of patients had hyperlipidemia, only 48.9% were on statin therapy. The mean age was 53.9±10.9 years, and the mean BMI was 26.1±5.69. Diabetes, hypertension, family history of CAD, and older age was more likely present in statin users (P &lt; 0.05 for all). In multivariate analysis, these variables and higher BMI were significantly associated with statin use in all four models (Table 1). For CAC quantification, Calcium Volume, AS, and Number of Lesions did not differ significantly between statin users and non-users, whereas Calcium Density was higher in statin users (OR = 1.19, CI = (1.02, 1.39), P = 0.025). Conclusions: Statin use is associated with higher Calcium Density but is not associated with differences in other CAC quantification methods in patients with suspected CAD.
Abstract 12544: Sex Differences in Cardiac Catheterization Outcomes Among Black Patients in an Urban Center
Authors: Kelechi O Weze, Nformbuh Asangmbeng, Eric Y Chang, Chidi Amah, Yasir Taha, Melvin Echols
Journal: Circulation (2022)

Introduction: Sex disparities persist in the management of CAD. Although between-racial and ethnic group disparities continue to exist, there are limited data regarding intra-race sex differences within African American (AA) populations. Thus, we describe the sex differences in outcomes among Black patients receiving left heart catheterization (LHC) in a large urban medical center (UMC). Methods: Using electronic health data, we extracted data of AA patients (pts) undergoing LHC between January 2014 to December 2019 from an UMC. Baseline demographics and management were compared between men and women. The primary outcome of interest was percutaneous coronary intervention (PCI), with secondary outcomes of coronary artery bypass graft (CABG) and Intra-aortic balloon pump (IABP). Outcomes were analyzed with chi-square testing and multivariable regression. Results: There were 3,379 LHC performed (42% in women). Men were relatively younger compared to women (63±11 vs 65±12, p&lt;0.001), had lower BMI (29±8 vs 33±9, p&lt;0.001), EF (45±15 vs 50±15, p&lt;0.001), and rates of health insurance (59% vs 66%, p&lt;0.001). Women had higher rates of dyslipidemia (42% vs 33%, p&lt;0.001), hypertension (87% vs 83%, p=0.001), and Type II DM (43.6% vs 33.6%, p&lt;0.001), but lower rates of smoking (30.5% vs 45%, p&lt;0.001). Men also had higher rates of STEMI 12.8% vs 5.2% and NSTEMI 29.6% vs 28.7% (P&lt;0.001). Men were more likely to receive PCI (40.5% vs 34.5%, p&lt;0.001), CABG (4.6% vs 2.3%, p=0.001), and IABP (2.1% vs 0.5%, p=0.001). After multivariable regression, men had higher odds of PCI (OR=1.15, p=0.15), CABG (OR=2.4, p=0.001), and IABP (OR=5.5, p=0.002). Conclusions: In this cohort of AA pts receiving LHC at an urban center, men were more likely to undergo interventions including PCI, CABG, and IABP as compared to women. Even among AA populations, significant sex differences occur. More work is needed to understand underlying factors and address healthcare disparities in this high-risk population.
Abstract 12393: Two-Year Clinical Outcome of Mid-Range Ejection Fraction at Admission in Patients With Acute Myocardial Infarction
Authors: Ho Sung Jeon, Young In Kim, Jung-Hee Lee, Dong-Hyuk Cho, Young Jun Park, Jung-Woo Son, Jun-Won Lee, Young Jin Youn, Sung-Gyun Ahn, Min-soo Ahn, Jang Young Kim, Byung-Su Yoo, Seung-Hwan Lee, Junghan Yoon, Dae Ryong Kang
Journal: Circulation (2022)

Introduction: The American Heart Association and European Society of cardiology guidelines reclassified heart failure according to left ventricular ejection fraction, recognizing patients with mid-range EF (mrEF; 40% to 49%) as a distinct group. However, studies on the clinical characteristics of mid-range EF patients and the occurrence of cardiovascular events in acute MI patients are insufficient. Methods: We categorized 6,553 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into three groups (reduced EF ; LVEF &lt; 40% at admission, mild-reduced EF ; LVEF 40 to 49%, preserved EF ;LVEF ≥50%). The primary endpoint was defined as any death at two-year. Secondary endpoints were defined as any myocardial infarction, any revascularization, patient-oriented composite outcome(POCE). Results: Compared to patients with other two groups, the reduced EF group had a highest overall mortality, POCE, and any MI (24.7% vs 8.3% vs 4.6%, p &lt; 0.0001, 33.0% vs 15.6% vs 12.4%, p&lt;0.0001, 3.9% vs 2.7% vs 2.6%, p&lt;0.0046). When mid-range EF group was designated as a reference, in multivariate analysis including all variables, significant differences with HFrEF group was found. (Hazard ratio ). When compared with HFpEF, only Model 1 and Model 2 showed a significant statistical difference (Model 1 ; 0.65 (0.53-0.81), Model 2 ; 0.56 (0.56-0.86). Conclusions: Followed up for two years, significant differences in survival rates were observed between the mid-range EF, reduced EF, and preserved EF group. After adjusting for common prognostic factors affecting the overall mortality rate, the reduced EF group had a significantly higher mortality rate than mid-range EF group, but no significant difference was observed between the preserved EF and the mid-range EF group.
Abstract 11784: The Estimated Appendicular Skeletal Muscle Mass Predicts Adverse Outcomes in Patients Under 65 Years With Coronary Artery Disease
Authors: ryota nishio, Dohi Tomotaka, Tatsuya Fukase, Mitsuhiro Takeuchi, Norihito Takahashi, Endo Hirohisa, Shinichiro Doi, Iwao Okai, Hiroshi Iwata, Shinya Okazaki, Katsumi MIYAUCHI, Hiroyuki Daida, Tohru Minamino
Journal: Circulation (2022)

Background: The impact of frailty, evaluated by the appendicular skeletal muscle mass (ASM) has been recognized as a predictor of adverse prognosis in elder patients with coronary artery disease (CAD). In recent years, formulas for estimating ASM using height, weight, sex, and age have been proposed for Asian population. However, a simple equation for estimating ASM has not been well validated in clinical, especially in younger patients. Methods: We enrolled 811 patients under 65 years with CAD who underwent percutaneous coronary intervention (PCI) at our hospital between 2010 and 2017. The mean age was 57 years and 89.6% were men. Patients were divided into 2 groups based on each ASM index (ASMI). Low ASMI was defined as the 20% lowest percentile of the study population (low ASMI; male &lt;7.6 and female &lt;5.5, high ASMI; male 7.6≤ and female 5.5≤). ASM was calculated by the following formula: 0.193 х bodyweight + 0.107хheight – 4.157 х gender – 0.037 х age – 2.631. Primary endpoint was 4P MACE (cardiovascular death, non-fatal myocardial infarction and non-fatal stroke and admission for heart failure). Results: During the median follow-up period of 5.2 years, cumulative incidence of events were significantly higher in the low ASMI group (Figure). After adjustment for important covariates, patients in the low ASMI groups had significantly higher all-cause mortality and MACE than those in the high ASMI groups (Crude; HR 1.98, 95% CI 1.16-3.24, p = 0.014, Model 1; HR 1.91, 95% CI 1.11-3.16, p = 0.02, Model 2; HR 2.23, 95% CI 1.18-4.02, p = 0.015) Conclusions: A low ASMI evaluated by a simple equation is an independent predictor of 4P MACE in younger patients with CAD.
Abstract 12707: The Association Between Beta-Blockers and Outcomes in Patients With Heart Failure and Alzheimer's Disease and Related Dementias
Authors: Lauren Gilstrap, Andrew Cohen, Gregory Ouellet, Parag Goyal, Barbara Gladders, Danette Flint, Jonathan Skinner
Journal: Circulation (2022)

Introduction: Contemporary HFrEF patients are older and have a higher prevalence of cognitive impairment compared to those studied in the original beta-blocker (BB) trials. While BB decrease mortality and morbidity in HFrEF, their use has been linked to higher fall risk and possibly acceleration of cognitive decline among older adults with Alzheimer’s Disease and Related Dementias (ADRD). The risk/benefit trade-off of beta blocker (BB) use in patients with HFrEF and dementia has not been examined. Methods: Using a 100% sample of patients enrolled in Medicare A, B and a 40% sample of D with ≥1 hospitalization for HFrEF between 2008 and 2018, we created a cohort of beneficiaries with HFrEF but no prior diagnosis of ADRD. We then subset to the population to those that developed ADRD in the year after their HFrEF hospitalization and compared BB use pre/post ADRD diagnosis and is association with outcomes using a time varying exposure. Results: The highest 1-year survival after ADRD diagnosis was observed among those continued on BB after ADRD diagnosis, regardless of whether they were on BB before (HR 0.427, 95% CI 0.406, 0.465, p&lt;0.001) the ADRD diagnosis or not (HR=0.629, 95% CI 00.545, 0.670, p&lt;0.001; Figure 1 ). The poorest survival was observed among those who had their BB stopped after their ADRD diagnosis (HR=2.34, 95% CI 2.15, 2.46). Conclusion: Among patients with HFrEF, stopping BB therapy after a diagnosis of ADRD is associated with the poorest survival. The best survival was observed among those continued on BB after ADRD diagnosis. Therefore, unless there is a clear clinical indication, BB therapy should not be stopped after a diagnosis of ADRD.
Abstract 11459: The Biochemical and Physiological Pathways From Obesity to Cardiovascular Disease: A Prospective Cohort Study of 404332 UK Biobank Participants
Authors: Ziyi Zhou, Solange Parra-Soto, Fanny Petermann-Rocha, Jirapitcha Boonpor, Paul Welsh, Carlos Celis-Morales, Naveed Sattar, Jill Pell, Frederick Ho
Journal: Circulation (2022)

Background: There are limited effective population measures to control obesity even though it is a major risk factor for chronic diseases. We explored the mechanisms linking obesity and cardiovascular diseases (CVDs), including atherosclerotic CVD (ASCVD) and heart failure (HF), which could be more effective targets for disease prevention. Methods: This is a prospective cohort study of 404,332 UK Biobank participants of white ethnicity who were free from CVDs, chronic diseases, and respiratory disease at baseline and had body mass index (BMI) ≥18.52. Data was collected at the baseline assessment between 2006 and 2010. Linkage to death registrations and hospital admission records was used to ascertain ASCVD and HF outcomes up to late 2021. Obesity is defined as BMI ≥302. Biomarkers included lipids, blood pressure, HbA1c, liver, and kidney function markers chosen based on results from trials and Mendelian randomisation studies. Cox proportional hazard models were used to estimate HRs and 95% confidence intervals (CIs). Mediation analysis based on g-formula was used to identify significant mediators as well as their relative importance for ASCVD and HF separately. Findings: Obesity (BMI ≥30 kg/m2) was associated with an increased risk of ASCVD (HR 1.20, 95% CI 1.16-1.24) and HF (HR 1.75, 95% CI 1.68-1.82) after adjusting for sociodemographic and lifestyle factors and use of statins and medications for blood pressure and diabetes. The strongest mediators for ASCVD were eGFR, blood pressure, and triglycerides, which accounted for 54.63%, 38.15% and 27.69% of the associations respectively; those for HF were eGFR (33.09%), CRP (10.32%), and HbA1c (7.45%). The mediators explained a much higher proportion of excess ASCVD risk than HF risk. Interpretation: Interventions that help individuals living with obesity to maintain healthy levels of lipids, blood pressure, HbA1c, and kidney function could potentially alleviate some of the ASCVD burdens. However, the HF burden could not be meaningfully reduced without weight management.
Abstract 11674: Acute Effects of Nicotine-Containing Product Challenges on Cardiovascular and Autonomic Function Among Electronic Cigarette Vapers, Combustible Cigarette Smokers, and Controls: The CLUES Study
Authors: Matthew C Tattersall, Christina M Hughey, Thomas M Piasecki, Claudia E Korcarz, Kristin Hansen, Michael C Fiore, Timothy B Baker, James H Stein
Journal: Circulation (2022)

Background: The acute cardiovascular effects of electronic nicotine delivery devices (ENDs) have not been well-characterized. We hypothesized differences in acute cardiovascular and autonomic function responses to use of ENDS by chronic ENDs users (“vapers”), use of combustible cigarettes by chronic “smokers,” and no product use among non-smoking/non-vaping controls. Methods: CLUES (HL1393301) was a cross-sectional study of 395 individuals: 164 exclusive vapers (exhaled carbon monoxide [CO] &lt;5 ppm, positive urine NicCheck I test), 117 exclusive smokers (CO &gt;5 ppm, positive urine NicCheck), and 114 non-vaping/non-smoking controls (CO &lt;5 ppm, negative urine NicCheck). We measured systolic and diastolic blood pressure (BP), heart rate (HR), brachial artery diameter, and time domain HR variability (root mean square differences in successive normal intervals [RMSSD]; % adjacent normal intervals &gt;50 ms [PNN50]) before and 15’ after a product use challenge. Linear mixed models were created to predict outcome measures from group, time, and group*time with age, sex, and race as covariates, followed by group contrasts via post-hoc t-tests with Bonferroni-corrected p values. Results: Vapers were a mean (SD) 27.4 (10.6) years old (39% female, 86% white) and had vaped for 4.1 (2.7) years. Smokers were 42.8 (13.8) years old (44% female, 56% white) and had smoked for 23.0 (13.0) years. Controls were 30.8 (11.9) years old (50% female, 69% white). Model-adjusted mean (95% CIs) outcomes and p values for between group differences in challenge responses are in the Figure. Compared to controls, vapers had greater increases in systolic BP, diastolic BP, and HR (all p &lt; 0.002) and greater reductions in brachial artery diameter, RMSSD, and PNN50 (all p &lt; 0.003) than controls, with values similar to smokers. Conclusion: Chronic vapers showed acute increases in BP and HR, vasoconstriction, and reductions in time domain HR variability after using ENDS, similar to cigarette use by smokers.
Abstract 11771: Impact of Overweight/Obesity/Higher Body Mass Index on Long-Term Major Adverse Cardiac Outcomes Following Chronic Total Occlusion-Percutaneous Coronary Interventions- A Systematic Review and Meta-Analysis
Authors: Rupak Desai, Advait Vasavada, Kshitij Mahajan, ananth vallabh guddeti, Swapnil Surpur, Syed Mohammad Moosi Raza, Mani Chandan Reddy Patlolla, Ehrima Fatima, Zarna Bambhroliya, Paul Gbemudu, Ankit Vyas
Journal: Circulation (2022)

Background: Obesity is usually associated with worse cardiovascular outcomes. However, fewer studies have evaluated its impact on long-term major adverse cardiovascular events (MACE) following CTO PCI. We conducted a meta-analysis to assess the same. Methods: PUBMED, Scopus, and EMBASE were systematically searched for studies reporting long-term (at least &gt;1 year) outcomes with obesity vs no obesity in patients with CTO PCI. MACE events [all-cause mortality, cardiac mortality, revascularization, restenosis/reocclusion, recurrent angina pectoris (RAP), target-vessel myocardial infarction (MI), heart failure, cardiac death, or ischemia-driven target-vessel revascularization (TVR) were the primary endpoint. Pooled odds ratios (OR) and heterogeneity were assessed with random-effects models and I2 statistics respectively. Subgroup analysis was performed to assess the risk by age group and follow-up duration. The leave-one-study-out method was used for sensitivity analysis. Results: After an initial electronic search of thirty-two studies, five studies were selected, and between 2016 to 2021 selected were included in the final analysis. The sample size consisted of 5022 patients with a median age of 63. No significant impact of higher BMI/obesity was seen overall on a median duration of 2.6 yrs [OR(95% CI)= 0.95 (0.82-1.11), p=0.53, I 2 = 90.86%)] (Fig 1). However, on a subgroup analysis, the geriatric age group (≥65 yrs) demonstrated an "Obesity Paradox" effect on MACE after CTO PCI, [OR (95%CI)=0.64 (0.47-0.88), I 2= 42.13, p&lt;0.01]. There was no difference in a subgroup analysis based on follow-up duration (≥3 years [OR (95%CI)=0.73 (0.42-1.27)] vs &lt;3 years OR (95%CI)=1.04 (0.84-1.27)]. Conclusions: Although higher BMI/obesity was not associated with overall long-term MACE in CTO PCI, the subgroup analysis demonstrated the "Obesity Paradox" (protective) effect in studies with a predominantly geriatric population.
Abstract 11109: Electrocardiogram-Based Deep Learning to Predict Peak Oxygen Consumption During Exercise
Authors: Shaan Khurshid, Timothy Churchill, Nathaniel Diamant, Paolo Di Achille, Christopher Reeder, Pulkit Singh, Meagan M Wasfy, Jennifer E Ho, Aaron L Baggish, Puneet Batra, Steven A Lubitz, James S Guseh
Journal: Circulation (2022)

Introduction: Peak oxygen consumption (V̇O2 Peak) is a robust marker of cardiovascular health. However, V̇O2 Peak assessment requires specialized exercise testing. Methods: We studied individuals who underwent cardiopulmonary exercise testing (CPET) with available resting 12-lead electrocardiogram (ECG) within 1 year. We developed a deep learning model to generate 320-dimensional representations of ECG waveforms. We trained and validated 3 penalized linear models to estimate V̇O2 Peak using 1) basic clinical factors (age, sex, and body mass index), 2) clinical factors plus routine ECG parameters (e.g., PR interval), and 3) clinical factors plus deep learning- ECG embeddings (“Deep ECG-V̇O2”). We assessed model performance by comparing Pearson correlation (r) and mean absolute error (MAE) against true V̇O2 Peak. Within a separate ambulatory sample, we assessed associations between Deep ECG-V̇O2-estimated V̇O2 Peak and incident outcomes using Cox proportional hazards models adjusted for age, sex, and body mass index. Results: The analysis set included 2,339 individuals (age 46±19 years, 37% female) who underwent CPET and was divided into development (n=1,891) and test (n=448) sets. Mean V̇O2 Peak was 33.6±14.4 mL/kg/min. In the test set, correlation and agreement with true V̇O2 Peak were favorable using Deep ECG-V̇O2 versus the comparison models ( Figure ). Within a separate set of 84,718 individuals, estimated V̇O2 Peak &lt;14 mL/kg/min (a clinical threshold for substantially impaired fitness) was associated with higher risks of incident atrial fibrillation (hazard ratio [HR] 1.36, 95% CI 1.21-1.54), myocardial infarction (HR 1.21, 95% CI 1.02-1.45), heart failure (HR 1.67, 95% CI 1.49-1.88), and all-cause death (HR 1.84, 95% CI 1.68-2.03) ( Figure ). Conclusions: Information encoded within 12-lead ECGs can estimate V̇O2 Peak. Estimated V̇O2 Peak demonstrates strong inverse relationships with incident cardiovascular disease and all-cause mortality.